Saturday, July 24, 2010

More Questions About Donald Berwick Surface

With the unvetted recess appointment of Donald Berwick to the Centers for Medicare and Medicaid Services (CMS), some interesting questions that would have been asked at his Senate confirmation hearing were skuttled, like this one:

Beyond that, the GOP is especially curious about a nonprofit organization Berwick founded, the Institute for Healthcare Improvement. A 501(c)(3) tax-exempt organization, the institute reported receiving $12.2 million in contributions and grants, among other revenues, in 2008 (the most recent year for which figures are publicly available). Given all the money that has flown around in the health care debate, Republicans wanted to know where the $12.2 million came from. The recess appointment meant that Berwick didn't have to answer.

The institute has also been very good to Berwick personally. He received $2.3 million in compensation in 2008 (a figure that included retirement funds), and was paid $637,006 in 2007 and $585,008 in 2006. On top of that, investigators discovered a little-noticed paragraph in an audit report revealing that in 2003 the institute's board of directors gave Berwick and his wife health coverage "from retirement until death."

This is no small issue since this man now controls nearly half of the half the US health care budget. I can assure you, doctors did not contribute that kind of money to Mr. Berwick's coffers.

24 comments:

Anonymous
said...

"This has won him the endorsement of the American Hospital Association, the American Medical Association and other non-partisan bodies. He has broad support from the health-care industry, which has implemented many of the safety and efficiency measures proposed by his think-tank, the Institute for Healthcare Improvement. Even Mark McClellan, a Bush-appointed predecessor in the CMS job, supports his nomination."from The Economisthttp://www.economist.com/node/16591317?story_id=16591317&CFID=136278046&CFTOKEN=86356389

The recent health care reform law has shown us that the endorsement of groups like the AMA is of little substantive value. I also find it sad that Anonymous would like to use a few names to imply that asking questions of Dr Berwick is unnecessary. As the WSJ recently argued, Berwick with $800B and rationing powers, is a much more significant appointment than Elena Kagan to the Supreme Court. And yet people like Anonymous would probably never suggest that she not be given an open hearing just because the ABA or some past administration official assures us she's OK. Furthermore, I find it hypocritical that someone who may eventually ration care for millions would not be subject to the same rationing, given his lifetime health insurance coverage. That smacks of so many of these other federal officials who make laws for the little people and yet have no intention of living within the same limits they set for others (is Congress not being covered by ObamaCare, Geithner/Rangle not paying their taxes, etc). Dr Donald Berwick should answer questions in front of Congress.

It is unfortunate that we have this stalemate in congress where the principle task of the party not in power is to delay the agenda of the majority party. Whether it is judicial appts. or critical heads of govermental bodies such as CMS, it is no wondor govrment cannot accomplish much if it takes years to get leadership in place. Anonymous senatorial holds need to be done away with and reasonable time frames put in place for congressional action on presidential appts, after which an appt can become automatic if congress does not act.

I do not like the idea of a presidential appt. not subjected to propr congressional oversight either, but I look at this more a failure of congress to act in a timely manner than an abuse of presidntial power. I would like to see Dr. Berwick answer those tough questions regarding IHI and explain why he feels he deserves compensation in excess of 2 million per year to head that organization. What exactly has IHI accomplished?

While political skepticism is a great thing, perhaps in this case it's not so warranted. The IHI is a revolutionary organization, which many doctors did contribute to, and many more support its goals. Patient safety isn't a political agenda, it's just the right thing to do.

While I totally believe in transparency in financial disclosures, I highly doubt that any agenda is being carried out through tax-deductible donations to the tax-exempt IHI.

Your source, The Washington Examiner, is a free tabloid whose owner has ordered the op-ed page to ONLY have conservative writers.

You ask who funds the foundation. I found these and partners, supporters on their website.Mayo Foundation, Dana Farber Cancer Institute, Baptist Memorial Health Care Corp, Baylor Health Care System, David Calkin Memorial Fund, Aetna Foundation, Robert Wood Johnson Foundation, Cardinal Health Foundation, Gordon and Betty Moor Foundation. Perhaps it is all a bunch of hooey and if so we should contact these organizations so they can file a suit. But before you nail him, I think it merits some deeper investigation.

As to Sen. McConnell withholding any "further" support for any Obama nominees, the threat is just laughable. My gosh, the GOP is running on no, no, NO! So you will forgive me if I am not shocked.

Rest easy! You can find a wealth of info at IHI.org about the institue he founded and you will be pleased to know that the Board of Directors and Fellows include Robt. Waller MD, President Emeritus Mayo Foundation, folks from Wellesley, Virginia Mason Med Ctr., U of N.C. @ Chapel Hill, Cincy Children's Hospital, Dartmouth, Harvard, and somebody from the House of Lords (UK). I bet there's not a marxist or communist among them. Also, the post-retirement health benefit present (lifetime)value was $120K - pretty much chicken feed when you figure how much money is floating around lobbyists who are taking Mitch McConnell out to lunch most days.

Keith: I'm no expert but suggest you take a look at their website. They sure seem to have a bunch of programs working.

"Little noticed paragraph" regarding the health insurance benefit? Who is the Washington Examiner kidding? Read the audit (they are ALL posted on their website, ihi.org) and there it is - plain as day - so even I can find it who has never read an audit report. Same size font and perfectly intelligible. Give me a break!

As I have admitted on this blog before, I am a regretful Obama voter. When someone told me he wanted to bring the NHS to America a month before I voted for him, I told her that was a wild conspiracy theory. I have since apologized to her. I now think that is exactly what he intends to do.

Obama in this clip:

"A single payer universal health care plan. That's what I'd like to see. But, as all of you know, we may not get there immediately because first we've gotta take back the White House, we've gotta take back the Senate...."

http://www.youtube.com/watch?v=fpAyan1fXCE

Obama in this clip:

"But I don't think we're gonna be able to eliminate employer coverage immediately. There's gonna be potentially some transition process. I can envision a decade out or 15 years out or 20 years out." (replace it with what???)

Keith - Thank God for the party of NO! Obama keeps asking us if we want to return to the failed policies of the Republicans that got us into this mess, or stick with the Democrats policies getting us out.

First, what DID get us into this mess?

Ask Bill Clinton and Michael Bloomberg - They say it was the housing bubble. Interestingly, the Republicans and the Fannie and Freddie regulator were trying to push for tighter restrictions in lending - and it was Democrats resisting.

But don't take my word for it, watch the videos for yourself:

Bill Clinton

http://www.youtube.com/watch?v=hfGWxqsKFmY

Congressional Hearing discussing Fannie and Freddie years before the collapse:

http://www.youtube.com/watch?v=_MGT_cSi7Rs&feature=related

Video of Barney Frank before the collapse: He says:

"...you're not going to see the collapse that you see when people talk about a bubble...Those of us on our committee in particular will continue to push for home ownership."

http://www.youtube.com/watch?v=iW5qKYfqALE&feature=player_embedded

Video of Barney Frank AFTER the collapse: He says:

"I was very much in disagreement with this push into homeownership..."

http://www.youtube.com/watch?v=xC9k3oB83z4&feature=player_embedded

Michael Bloomberg on the causes of the economic collapse:

http://www.youtube.com/watch?v=wXhND01U734

Second - The "policies" of the Republicans, according to Politifact led us to:

"According to the Bureau of Labor Statistics, the economy added more jobs than it lost during 50 out of 52 months between September 2003 and December 2007. The economy lost jobs over two months during that stretch -- between June 2007 and July 2007 (20,000 jobs) and between July 2007 and August 2007 (71,000).

That said, Obama's figures are worse than any of his postwar predecessors'. The economy has shed between 2.4 million and 3.1 million jobs during the 18 months he's been in office, depending on whether you start counting with the January 2009 figures or the February 2009 figures.

So if Gillespie's point is that Bush's tax cuts led to record revenues, they did -- for 2007 at least -- but that was a record aided by a the largest, non-recession economy in American history."

Record revenues. LARGEST non-recession economy in American history. He calls THAT failure?

None of us could argue about the importance of patient safety - it is a laudible goal indeed.

Having said that, Mr. Berwick enjoyed a $2.3 million salary (a nearly 4-fold year-over-year increase) at a time when the overwhelming concern about the survival of our health care system is its exorbitant costs.

I'm not sure I have ever seen a clearer example of the costs that added bureaucracy brings to our health care system and ignoring this fact is precisely why we have the problems we do in health care.

Reviewed their website and it appears to be replete with projects designed to further improve our health care system. Still it would be nice to have Dr. Berwick describe their mission and accomplishments, which would likely stregthen his support. I think he would need to justify his and several members of the institutes compensation. Why such outsized compensation for what is a non profit organization? He should explain this in hearings before obtaining this important appt.

Jodi,

Why the late appt.? I suspect that Dr. Berwick may not have wanted the job without the health care law in place. Given his agenda of patient centered health care improvement, he likely would have seen little that he could do to positively affect health care without this sweeping law. Once it was passed, the appt. was made fairly quickly.

Your examples of articles critical of the British NHS are noted. I don't think we are going to obtain perfection with any health care system. I think our goal should be to look to these examples of what appears to be a fairly successful national health care program and modify them to correct for these deficiencies. Great Britain has better health care statistics than the US for a variety of measures including longevity. One needs to explain this if we feel our health care system is so superior. You also need to explain how you would have us finance these very expensive treatments, often with very limited therapeutic beneifits, with Meidcare rapidly running out of funds and health premiums soaring to levels that are unaffordable for an ever expanding portion of our population. Bottom line, economic principles demand some form of rationing; you can accomplish it the way we currently do on the basis of ability to pay (whther one can afford insurance or not) or the way many other industrialized countries do which is to limit access to certain minimally beneficial treatments. It is interesting that one of your examples involves the denial of Britain to allow Avastin for treatment of breast and colon cancer. Our FDA recently reviewed Avastin for breast cancer and found it ineffective resulting in its removal of its indication for this condition. Avastin represent 1 billion in Roches 6 billion in revenue for a drug that was shown to give patients 4 months of additional existence. I for one think we could find a better use for 1 billion dollars and that is apparently what the NHS in Britain is attempting to do. We will not be able to continue to afford these marginally effective, end of life treatments without taking resources away form more important and pressing issues.

Reviewed their website and it appears to be replete with projects designed to further improve our health care system. Still it would be nice to have Dr. Berwick describe their mission and accomplishments, which would likely stregthen his support. I think he would need to justify his and several members of the institutes compensation. Why such outsized compensation for what is a non profit organization? He should explain this in hearings before obtaining this important appt.

Jodi,

Why the late appt.? I suspect that Dr. Berwick may not have wanted the job without the health care law in place. Given his agenda of patient centered health care improvement, he likely would have seen little that he could do to positively affect health care without this sweeping law. Once it was passed, the appt. was made fairly quickly.

Your examples of articles critical of the British NHS are noted. I don't think we are going to obtain perfection with any health care system. I think our goal should be to look to these examples of what appears to be a fairly successful national health care program and modify them to correct for these deficiencies. Great Britain has better health care statistics than the US for a variety of measures including longevity. One needs to explain this if we feel our health care system is so superior. You also need to explain how you would have us finance these very expensive treatments, often with very limited therapeutic beneifits, with Meidcare rapidly running out of funds and health premiums soaring to levels that are unaffordable for an ever expanding portion of our population. Bottom line, economic principles demand some form of rationing; you can accomplish it the way we currently do on the basis of ability to pay (whther one can afford insurance or not) or the way many other industrialized countries do which is to limit access to certain minimally beneficial treatments. It is interesting that one of your examples involves the denial of Britain to allow Avastin for treatment of breast and colon cancer. Our FDA recently reviewed Avastin for breast cancer and found it ineffective resulting in its removal of its indication for this condition. Avastin represent 1 billion in Roches 6 billion in revenue for a drug that was shown to give patients 4 months of additional existence. I for one think we could find a better use for 1 billion dollars and that is apparently what the NHS in Britain is attempting to do. We will not be able to continue to afford these marginally effective, end of life treatments without taking resources away form more important and pressing issues.

The source for Dr. Berwick's compensation seems to always come from The Washington Times, founded by and until recently run by the Rev. Sun Myung Moon (of Moonie fame). It also ran an editorial that linked healthcare reform to Nazi policies.

Now if the 2.3M compensation is true, it is indeed outrageous. But I'm going to need some SOURCE that is more credible than the Washington Times or a GOP blog. Have you checked this out with the IHI?

OK. IRS reporting shows 2.4M income. However, that figure needs a closer look. The following is from the Foundation Center regarding Dr. Berwick's compensation:

However, the Cambridge, Mass.-based IHI issued a one-page fact sheet along with its tax forms explaining that one-time events led to reporting of total compensation for Berwick that “is significantly larger than the actual compensation related strictly to 2009 activities.”

Berwick had to report as taxable wages his contributions in a 7-year-old retirement plan that vested in 2009 because of accounting rules, even though it was reported on prior Form 990s, IHI Chief Financial Officer Amy Hosford-Swan says. And secondly, since the IRS required all taxable wages recorded in 2009 be disclosed on the tax forms, this amount showed up as income again even though it was reported previously, she says.

“As a result, there was seven years of retirement benefits that was reported in one chunk,” IHI spokesman Jonathan Small says. “This will never happen again. It was a one-time occurrence for him.”

Of the $2.36 million in total compensation for Berwick reported on the most recent tax form, $1.4 million came from this irregular reporting of deferred compensation and retirement benefits. Of the remainder, Berwick received about $474,248 in base compensation, $147,000 in bonuses, $300,262 in the Management Team Flexible Benefit Plan, and $26,241 in other taxable benefits.

That's a 3% decrease in base compensation from the $490,006 Berwick received the year before.

End of cut and paste.

So, yes, it is a big compensation package but that year-over-year increase is not fair reporting. It looks something like the recent Beitbark (no idea how to spell his name) "reporting".

P.S. The web is a wonderful thing! I am astounded that one can find this kind of information on the web.

It seems a significant chunk of IHI's money (to the tune of over $1.8 million) went to grants for Sub-sahara Africa in 2008 (a new initiative). While this might be a noble goal for a separate non-profit, should Americans expect they'll be funding the world's health care needs when fees are paid by our hospitals to the Institute for their safety programs?

Dr. Berwick was nominated in mid May, was he not? Two months to nominate someone for a position that is so dire and URGENT that it cannot await the due process which allows Americans to hear from, and about, a man with such power over their lives?

IF giving people health care was all we needed to do to increase longevity, decrease obesity, stop smoking, stop gun violence, etc, then the young among us who have "free" health care (Medicaid) would be outdoing all of us on those statistics.

But that is not the case. Why? Because a health care system is neither the cause of, nor the solution to these behavioral and societal health related problems that plague those living in poverty. Same goes for everyone else.

A college textbooks noted two studies (and only these two studies) that looked at the "determinants of individual health status". They listed them, Lifestyle/behavior 50%, Genetics 20%, Environment/Society 20%, Health Care 10%.

Here is a U Penn paper on this topic:

"One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD countries would improve from 14th to 9th, while US women would move from 18th to 7th. Recent trends in obesity are also more adverse in the US than in other developed countries."

repository.upenn.edu/cgi/viewcontent.cgi?article=1012&...

We lead the world in obesity, tobacco, alcohol, cocaine, auto accidents, rapes, gun shot violence, etc. But we have no medical "cure" for those things.

I agree we need a form of rationing to put downward pressure on utilization. But "patient-centered" rationing via high-deductibles with HSAs for everyone except the poor, and policies whose premiums include things like immunizations and annual checks, is much more humane in my opinion than some far away government body doing the rationing for us, leaving EVERY one of us NO recourse or choice in the matter.

IF giving people health care was all we needed to do to increase longevity, decrease obesity, stop smoking, stop gun violence, etc, then the young among us who have "free" health care (Medicaid) would be outdoing all of us on those statistics.

But that is not the case. Why? Because a health care system is neither the cause of, nor the solution to these behavioral and societal health related problems that plague those living in poverty. Same goes for everyone else.

A college textbook noted two studies (and only these two studies) that looked at the "determinants of individual health status". They listed them, Lifestyle/behavior 50%, Genetics 20%, Environment/Society 20%, Health Care 10%.

Here is a U Penn paper on this topic:

repository.upenn.edu/cgi/viewcontent.cgi?article=1012&...

Notice bottom of page 3, top of 4. If we factored out smoking alone our longevity statistics rise dramatically. Think if we did that with obesity?

We lead the world in obesity, tobacco, alcohol, cocaine, auto accidents, rapes, gun shot violence, etc. But we have no medical "cure" for those things.

I agree we need a form of rationing to put downward pressure on utilization. But "patient-centered" rationing via high-deductibles with HSAs for everyone except the poor, and policies whose premiums include things like immunizations and annual checks, is much more humane in my opinion than some far away government body doing the rationing for us, leaving EVERY one of us NO recourse or choice in the matter.

The health care bill was signed on March 24th. Obama sent Berwick's nomination to the senate on April 19th.

The guy has a few other pressing problems on his plate, so I think he deserves a pass on his 3 week delay.

You might also explain why the average lifespan in this country has increased from around 50 to ~76 years of age if not for modern medicine. George Washington died of acute pharyngitis which is unheard of today (Benjamin Rush actually hastened his demise by performing bloodletting on him to remove the toxins from his body). While I agree that lifestyle plays a big role along with proper nutrition and housing, to totally negate the postivie benefits of modern antibiotics and vaccines as tangible examples of medical life extenders is absurd.

Finally, to suggest that Obama has caused the loss of jobs while it is clear that the economic recession began well before he took office is another absurdity. It is as absurd as blaming George Bush for 9/11. Economic decisions made months to years in advance often come to roost on another presidents watch, and this is clearly an example of poor decisions made by both prior democratic and republican presidents causing the current economic debacle. I ask you to point out one piece of legislation that Obama has passed or even proposed and how it could have caused the crumbling of the housing market and the near failure of our major banks. All those policies that led to this crisis were set in place many years before, including the creation of Fannie Mae and Feddie Mac.

I am arguing against the idea that the health care system is the reason for, or the answer to, the lower life expectancy we see in this country compared to other OECD countries. I am arguing against the idea that all we have to do is provide people with health care and they'll be, well, "healthy", when other things play a bigger role.

I didn't suggest Obama caused housing bubble and crash. But he is asking us to choose in November between failed policies of Republicans that got us into this mess, and Dem policies getting us out. Yet Dems largely contributed to the housing bubble and they contributed to the high national debt and deficit as well.

Through HIS "choice" campaign, he puts unemployment records of Dems versus Reps on the table for discussion.

Here is the debt to gdp ratio as it relates to Congress (aka, the "purse" strings) since '87.

'87-'95 - Dem Congress - debt rising

'96-'01 - Rep - debt lowering

'01-'03 - Split - Debt rising

'03-'07 - Rep - Debt rising

'07-now - Dem - Debt explodes

Wikipedia:

"from 2003-2007 the government spent roughly $1.20 for each $1.00 it collected in taxes. This increased to $1.40 in FY2008 and $1.90 in FY2009. Since 1970, the U.S. Federal Government has run deficits for all but four years (1998–2001)."

Increase '08 - Dem CongressBalanced '98-'01 - Rep Congress

I am not arguing that Dems are totally to blame, but they are largely responsible, TOO.

I argue against the Dems insistence that the Republicans are to blame and Dems are not, because that is grossly inaccurate and highly misleading.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.